Provider Demographics
NPI:1174917512
Name:BERG, ALISON (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:BERG
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 S CONGRESS AVE STE G
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8488
Mailing Address - Country:US
Mailing Address - Phone:561-926-5609
Mailing Address - Fax:
Practice Address - Street 1:3600 S CONGRESS AVE STE G
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8488
Practice Address - Country:US
Practice Address - Phone:561-926-5609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14004235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016604900Medicaid